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Uniform Title African Journal of Health Professions Education

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On Being Agents of Change: A Qualitative Study of Elective Experiences of Medical Students at the Faculty of Health Sciences; University of Cape Town; South Africa / Irlam; James Pienaar; Lunelle Reid; Stephen

Background. Student electives during the 5th year of the University of Cape Town (UCT) medical curriculum provide a 4-week work experience in the health system. The reflective reports of past students indicate that the electives may significantly shape their developing identities as health professionals and agents of change. Objective. To better understand how 5th-year medical elective students perceive themselves as agents of change to strengthen the elective programme in the Faculty of Health Sciences; UCT. The hypothesis was that the more choice that students are given over their learning; the greater is their sense of agency. Methods. Thirteen 5th-year student volunteers participated in four focus group discussions soon after completing their electives in district; regional or tertiary health facilities in the South African health system. Thematic analysis of the transcripts was performed independently by two of the authors. Results. Key themes were the importance of providing holistic patient-centred care; becoming a competent health professional; working within the health team and advocating for a better health system. The elective experience helped students to be more confident in their abilities and to better understand how to effect change at a clinical and health system level. Conclusion. This study supported the hypothesis that the more choice students have over their learning; the greater is their sense of agency. The electives are appreciated as opportunities to develop clinical skills and competencies and to better understand the role of future doctors within the health team and health system. The value of the UCT elective programme could be enhanced by greater promotion; funding for rural electives; and post-elective peer-topeer feedback sessions. This study will inform planning for an extended 2016 medical elective programme in the Faculty.

Background. Student electives during the 5th year of the University of Cape Town (UCT) medical curriculum provide a 4-week work experience in the health system. The reflective reports of past students indicate that the electives may significantly shape their developing identities as health professionals and agents of change. Objective. To better understand how 5th-year medical elective students perceive themselves as agents of change to strengthen the elective programme in the Faculty of Health Sciences; UCT. The hypothesis was that the more choice that students are given over their learning; the greater is their sense of agency. Methods. Thirteen 5th-year student volunteers participated in four focus group discussions soon after completing their electives in district; regional or tertiary health facilities in the South African health system. Thematic analysis of the transcripts was performed independently by two of the authors. Results. Key themes were the importance of providing holistic patient-centred care; becoming a competent health professional; working within the health team and advocating for a better health system. The elective experience helped students to be more confident in their abilities and to better understand how to effect change at a clinical and health system level. Conclusion. This study supported the hypothesis that the more choice students have over their learning; the greater is their sense of agency. The electives are appreciated as opportunities to develop clinical skills and competencies and to better understand the role of future doctors within the health team and health system. The value of the UCT elective programme could be enhanced by greater promotion; funding for rural electives; and post-elective peer-topeer feedback sessions. This study will inform planning for an extended 2016 medical elective programme in the Faculty.

Background. University students are exposed to a multitude of stressors that may impact on their performance. The nature of health sciences education generally involves early engagement with patients and communities; which may add to the stressors inherent to university life. There is sparse information on stressors in the oral hygiene educational environment. Objective. To determine perceived stressors and the level of burnout among oral hygiene students at the University of the Western Cape; Cape Town; South Africa. Method. A descriptive; cross-sectional study design was used. The study sample included all students in the Bachelor of Oral Health (BOH) degree during 2012 (N=89). A self-administered questionnaire was used to gather data. Three parameters were measured; i.e. (i) demographic characteristics; (ii) perceived sources of stress; using a modified Dental Environment Stress (DES) questionnaire; and (iii) burnout; using the Maslach Burnout Inventory (MBI). Results. Respondents were mostly female (74%) and primarily in the 18 - 25-year age group (92%). First- and 2nd-year students identified fear of failing and study load as major stressors. Stressors related to a lack of basic needs were identified as major stressors by 25% of 1st-year students. Third-year students identified clinical quotas; supervision and patients being late as major stressors. MBI scores indicated that students were not at risk forburnout; however; most students (66.2%) scored high on emotional exhaustion (EE). Conclusion. Oral hygiene students identified stressors in their learning environment. There was a progressive increase in EE across academic years. The results suggest that interventions should be tailored for specific academic year groups.

Background. University students are exposed to a multitude of stressors that may impact on their performance. The nature of health sciences education generally involves early engagement with patients and communities; which may add to the stressors inherent to university life. There is sparse information on stressors in the oral hygiene educational environment. Objective. To determine perceived stressors and the level of burnout among oral hygiene students at the University of the Western Cape; Cape Town; South Africa. Method. A descriptive; cross-sectional study design was used. The study sample included all students in the Bachelor of Oral Health (BOH) degree during 2012 (N=89). A self-administered questionnaire was used to gather data. Three parameters were measured; i.e. (i) demographic characteristics; (ii) perceived sources of stress; using a modified Dental Environment Stress (DES) questionnaire; and (iii) burnout; using the Maslach Burnout Inventory (MBI). Results. Respondents were mostly female (74%) and primarily in the 18 - 25-year age group (92%). First- and 2nd-year students identified fear of failing and study load as major stressors. Stressors related to a lack of basic needs were identified as major stressors by 25% of 1st-year students. Third-year students identified clinical quotas; supervision and patients being late as major stressors. MBI scores indicated that students were not at risk forburnout; however; most students (66.2%) scored high on emotional exhaustion (EE). Conclusion. Oral hygiene students identified stressors in their learning environment. There was a progressive increase in EE across academic years. The results suggest that interventions should be tailored for specific academic year groups.

An Exploration into the Awareness and Perceptions of Medical Students of the Psychosociocultural Factors which Influence the Consultation: Implications for Teaching and Learning of Health Professionals / Matthews; Margaret Glynnis Diab; Paula N.

An Exploration into the Awareness and Perceptions of Medical Students of the Psychosociocultural Factors which Influence the Consultation: Implications for Teaching and Learning of Health Professionals

Background. South African society is undergoing rapid changes; and includes people from different cultures; beliefs and social backgrounds. Research suggests that these contextual influences have an important bearing on how patients present and relate to healthcare providers. Medical students; too; have a life-world based on their own backgrounds and cultures; and may find relating to a patient with a different life-world challenging. Objectives. To explore students' awareness and perceptions of how psychosociocultural factors in a multicultural society influence the consultation; and to suggest adaptations for teaching. Methods. Focus group discussions were conducted with final-year medical students in the Family Medicine rotation. Some of the students had viewed a video of a consultation with an isiZulu-speaking patient; and completed a self-reflection learning task. Audio recordings were transcribed and analysed thematically. Results. Exposure to patients in the clinical years had made students aware of the challenges of cultural diversity; although they felt under-prepared to deal with this. Students alluded to the influences of their own cultures; of cultural similarities as well as differences; the roles and behaviours of doctors and patients in cross-cultural consultations; the potential knowledge and experience gap that exists across cultures; and an awareness of the need for patient-centredness. Conclusion. Students should be assisted to improve their cultural competence. Recommendations are made for using various methods; including critical incidents and visual learning to provide opportunities for reflexive practice and transformative learning. Educators must be equipped to address learning objectives relating to cultural competence.

Background. South African society is undergoing rapid changes; and includes people from different cultures; beliefs and social backgrounds. Research suggests that these contextual influences have an important bearing on how patients present and relate to healthcare providers. Medical students; too; have a life-world based on their own backgrounds and cultures; and may find relating to a patient with a different life-world challenging. Objectives. To explore students' awareness and perceptions of how psychosociocultural factors in a multicultural society influence the consultation; and to suggest adaptations for teaching. Methods. Focus group discussions were conducted with final-year medical students in the Family Medicine rotation. Some of the students had viewed a video of a consultation with an isiZulu-speaking patient; and completed a self-reflection learning task. Audio recordings were transcribed and analysed thematically. Results. Exposure to patients in the clinical years had made students aware of the challenges of cultural diversity; although they felt under-prepared to deal with this. Students alluded to the influences of their own cultures; of cultural similarities as well as differences; the roles and behaviours of doctors and patients in cross-cultural consultations; the potential knowledge and experience gap that exists across cultures; and an awareness of the need for patient-centredness. Conclusion. Students should be assisted to improve their cultural competence. Recommendations are made for using various methods; including critical incidents and visual learning to provide opportunities for reflexive practice and transformative learning. Educators must be equipped to address learning objectives relating to cultural competence.

Background. The creating; maintenance and storage of patients' medical records is an important competence for the professional training of a dental student. Objective. Owing to the unsatisfactory state of dental records at the students' clinic; the objective of this study was to obtain information from undergraduate dental students on the factors that affect this process and elicit recommendations for improvement. Methods. This qualitative cross-sectional study used focus group discussions with 4th- and 5th-year dental students for data collection. Data were captured through a written transcript and an audio recorder. The data were transcribed and analysed manually through developing themes; which were compared with the literature and interpreted. Results. Three themes emerged: (i) Poorly designed clerking forms. The clerking forms were deemed to have a poor design with inadequate space for clinical notes. It was recommended that they be redesigned. (ii) Inadequate storage space. Space for storing patient records was deemed inadequate and a referencing system for file retrieval was lacking. It was recommended that more space be allocated for storage; with a referencing system for easy file retrieval. (iii) Poor maintenance of records. Patients' records; especially radiographs; were not well labelled and stored. It was recommended that drug envelopes be utilised to store radiographs. An electronic system was deemed the ultimate solution to this problem. Conclusion. The general perception was that the current paper-based record system at the clinic was unsatisfactory. Therefore; there is a need to improve the maintenance and storage of records; and to change to a more efficient electronic system. The students' attitude towards record keeping was found to be questionable; with a need to be addressed as part of teaching and learning in the curriculum. Lecturers were deemed to have a bigger role to play in the record-keeping process.

Background. The creating; maintenance and storage of patients' medical records is an important competence for the professional training of a dental student. Objective. Owing to the unsatisfactory state of dental records at the students' clinic; the objective of this study was to obtain information from undergraduate dental students on the factors that affect this process and elicit recommendations for improvement. Methods. This qualitative cross-sectional study used focus group discussions with 4th- and 5th-year dental students for data collection. Data were captured through a written transcript and an audio recorder. The data were transcribed and analysed manually through developing themes; which were compared with the literature and interpreted. Results. Three themes emerged: (i) Poorly designed clerking forms. The clerking forms were deemed to have a poor design with inadequate space for clinical notes. It was recommended that they be redesigned. (ii) Inadequate storage space. Space for storing patient records was deemed inadequate and a referencing system for file retrieval was lacking. It was recommended that more space be allocated for storage; with a referencing system for easy file retrieval. (iii) Poor maintenance of records. Patients' records; especially radiographs; were not well labelled and stored. It was recommended that drug envelopes be utilised to store radiographs. An electronic system was deemed the ultimate solution to this problem. Conclusion. The general perception was that the current paper-based record system at the clinic was unsatisfactory. Therefore; there is a need to improve the maintenance and storage of records; and to change to a more efficient electronic system. The students' attitude towards record keeping was found to be questionable; with a need to be addressed as part of teaching and learning in the curriculum. Lecturers were deemed to have a bigger role to play in the record-keeping process.

The Forensic Autopsy as a Teaching tool: Attitudes and Perceptions of Undergraduate Medical Students at the University of Pretoria; South Africa / Lorraine du Toit-PrinslooPickworth; Glynis Saayman; Gert

Background. Numerous articles have been published on the use of autopsies in training medical students in anatomy and different branches of pathology. Some authors have described the emotional response of students who attend such postmortem sessions. Forensic pathology is an important subdivision of pathology. In some countries undergraduate medical students are expected to attend postmortem examinations on persons who died from traumatic causes. Objective. To determine the attitudes and perceptions of 5th-year medical students with regard to forensic postmortem examinations at the University of Pretoria; South Africa. Methods. A questionnaire was voluntarily completed by medical students on the last day of the practical rotation.Results. The overall rating of the practical rotation was 82%. The strengths; weaknesses; opportunities and threats (SWOT) analysis indicated the following as strengths: record keeping; legislation review and traumatology description; as weaknesses: emotional trauma and nightmares; as opportunities: the attendance of autopsies; and as threats: physical dangers. Conclusion. The current study was similar to international studies with regard to students' emotional response to attending autopsies. The autopsy remains a valuable teaching tool for undergraduate students. Emotional support is currently available for all students to assist them in overcoming their fear of attending forensic autopsy sessions.

Background. Numerous articles have been published on the use of autopsies in training medical students in anatomy and different branches of pathology. Some authors have described the emotional response of students who attend such postmortem sessions. Forensic pathology is an important subdivision of pathology. In some countries undergraduate medical students are expected to attend postmortem examinations on persons who died from traumatic causes. Objective. To determine the attitudes and perceptions of 5th-year medical students with regard to forensic postmortem examinations at the University of Pretoria; South Africa. Methods. A questionnaire was voluntarily completed by medical students on the last day of the practical rotation.Results. The overall rating of the practical rotation was 82%. The strengths; weaknesses; opportunities and threats (SWOT) analysis indicated the following as strengths: record keeping; legislation review and traumatology description; as weaknesses: emotional trauma and nightmares; as opportunities: the attendance of autopsies; and as threats: physical dangers. Conclusion. The current study was similar to international studies with regard to students' emotional response to attending autopsies. The autopsy remains a valuable teaching tool for undergraduate students. Emotional support is currently available for all students to assist them in overcoming their fear of attending forensic autopsy sessions.

An Inferential Comparison between the Capabilities and Achievements of 1st-Year Medical and Nursing Students at the University of the Free State; Bloemfontein; South Africa / Gerber; A. M. Botes; R. Vorster; A.